ONC Chief Vision Of An Interoperable Future

As the fifth head of the Office of the National Coordinator for Health Information Technology, just four months into the job, she will oversee the winding down of many programs started and run by her two predecessors.

Moving forward, the ONC’s role will be “less (about) overseeing grant programs and (more about) making sure that money is being spent properly,” DeSalvo said in an interview for our coverage of the 10th anniversary of the creation of the ONC this month.

“I talked about this when I first walked in the door (Jan. 13), knowing that we’d need to do it,” she said. “And that means we move ourselves from a structure that’s set up more for grant-making, to one that’s able to do policy and environmental-level systems change. That means that we really have to think about how we’re leveraging all of our policy talent and policy opportunities, and thinking all the time about how to be a convener and a communicator.”

On her arrival, DeSalvo said she was pleasantly surprised to see how much work the ONC was leading or coordinating, but that was being carried out by private-sector individuals. “There are thousands of people in this country who are volunteering their time in significant ways to see that we get this right, to see that we can capture standardized data, to sort out how to make the systems truly, meaningfully interoperable and put the data to good use,” she noted.

DeSalvo is a fan of the regional extension center program. With its four-year assignment and $688 million in federal funding running out, DeSalvo said she’d like to see the RECs survive. First tasked with promoting electronic health record adoption and meaningful use, the 62 RECs cover every state, and offer a unique opportunity to facilitate two-way communication between innovators and policy makers, she said.

“It’s a great way to bring back information to help inform policy,” DeSalvo said. “I think the opportunity is there.”

DeSalvo comes to the ONC from New Orleans, where she served as the city health commissioner. That background has already colored her thinking toward one of the great unmet challenges for the nation’s health IT program—total interoperability—which would provide the capability to call up a patient’s medical record from wherever they are located, whenever it is needed.

“My experience of 20 years in the practice of medicine is that patients try to do the right things, because they can think for themselves,” DeSalvo said. “And it’s not always what we would think. So the idea that this information would be out there and available wherever the person landed, that’s what I really want.”

She added, “I want to know, if this patient has to go somewhere else for care, that the information of the prior-care event is available and follows them,” and not just to where a provider wants them to go, she said.

“It’s a really important distinction and that’s the reason the idea about this query-based (interoperability) is powerful to me,” she said. She’s set a goal to have query-based interoperability in widespread use by 2017.

By then, she said, “My hope is that that kind of structural stuff will be so commonplace” healthcare can focus on bigger things, like using IT to develop a “learning healthcare system”, as envisioned by the Institute of Medicine, “and that’s a very exciting future,” she said.